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Evidence-Based Practice (EBP) is a relatively new effort to deliver better health at a lower cost. It rests on the following assumptions (among others):
- Best practices treatment rubrics can be created for individual medical conditions
- The treatment can be delivered and executed by trained medical professionals
- Delivery and execution can be standardized across all patient receiving the treatment
- Objective evaluation of the treatment outcome is possible
- Data can be collected and analyzed to verify that the treatment rubric increases quality of care
- EBP will lead to lower costs for RehabCare and yield higher patient satisfaction
Are these assumptions reasonable?
RehabCare has data from some of the programs that were developed in-house that can help us assess whether there is any evidence that EBP is a reasonable direction to pursue.
- RehabCare Clinical Practice Guidelines aim to provide clinicians with an interdisciplinary approach to the evaluation, treatment planning, and problem solving issues for a wide array of diagnoses and impairments. Physical therapy, occupational therapy, speech & language pathology, along with nursing and neuropsychology disciplines have been combined into a comprehensive and pragmatic manual for each of the impairment categories. This allows RehabCare clinicians to provide consistent management of patients within a discipline, across all post-acute settings, and throughout all RehabCare locations. Current available practice guidelines include:
- Brain Injury
- Cognitive and Communication Disorders
- Aphasia
- Cognitive-Linguistics
- Dementia
- Dysarthria
- Dysphagia
- Memory
- Guillain Barré Syndrome
- Lower Extremity Amputee
- Multiple Sclerosis
- Parkinson’s Disease
- Pulmonary Rehabilitation
- Spinal Cord Injury
- Stroke
- Centers for Orthopedic Rehabilitation Excellence (CORE) is RehabCare’s unique treatment program for total joint replacement patients no longer qualifying for an in-patient rehabilitation stay. Total hip and knee patient outcomes will be compared with those receiving rehabilitation services in CORE skilled nursing facilities (SNFs), non-CORE SNFs, and acute in-patient rehabilitation facilities to determine if CORE patients achieve the same or better functional outcomes at a lower cost.
- RehabCare is participating in its first nationwide research project, the JOINTS Study, which is aimed at answering a controversial issue surrounding the rehabilitation of patients receiving hip and knee replacements. The issue is whether these patients experience better or more cost-effective care in an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). Medicare’s enforcement of its 75% Rule for IRFs is transitioning treatment for most joint replacement patients away from inpatient rehab and toward treatment in SNFs or other less costly settings. However, there is little clinical evidence comparing the outcomes achieved in either of these settings. Determining where these patients receive the best rehabilitation is an important issue, as the number of patients undergoing this type of surgery in the past decade has increased by 50 percent. This study is being coordinated by National Rehabilitation Hospital and The Institute for Clinical Outcomes Research, and will compare the outcomes and cost of care between 1,400 IRF patients and 1,400 SNF patients receiving therapy for joint replacement.
- Another RehabCare research initiative related to the JOINTS Study aims to increase awareness and provide CMS with data on patients who have undergone either hip or knee replacement surgeries and have been discharged to home directly from the hospital. This growing patient population bypasses the traditional need to convalesce in a skilled nursing setting by receiving rehabilitation in a home health setting. It is yet to be determined whether this discharge pathway is more appropriate or cost effective.
- RehabCare is participating in another nationwide research initiative with the Frazier Rehabilitation Institute. This study will look at what type of care provides which patients the best outcomes for patients with a primary diagnosis of cardiac or pulmonary dysfunction. Just as CMS restricts access to IRFs for certain joint replacement patients, it has also limited cardiac or pulmonary patients' access to IRFs for rehab.
- RehabCare has partnered with Dr. Katherine Burns, an orthopedic surgeon with Signature Health Services, Inc. and one of the nation's leading authorities on arthroscopic repair of rotator cuff tears, to conduct a study on the effectiveness of various post arthroscopic rehabilitation protocols. Subjects in the control group will receive the traditional protocol currently used by most rehabilitation facilities. The experimental group will take part in an accelerated rehabilitation program designed by Dr. Burns and the RehabCare Clinical R&D department. It is hypothesized that this protocol will enhance treatment outcomes and reduces the number of treatment visits.
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